Innovation in Action

Pediatric Innovation Cluster

Testing new measures of resilience and the effects of stress in early childhood

Launched in June 2018, the Pediatric Innovation Cluster (PIC) is comprised of eight primary care practices across the United States that are working together to field-test new biological measures of stress effects and resilience and behavioral measures of core capacities (e.g., attention and executive function skills) that are being validated by the JPB Research Network on Toxic Stress. PIC practice sites are also evaluating their own programs and strategies in light of the needs of the families they serve, and testing out new interventions in response to those identified needs. Each PIC site team consists of a pediatrician, a research coordinator, and a parent or community member affiliated with the practice.

What is an Innovation Cluster?

Innovation clusters are multi-site collaborations that have been created to facilitate shared learning across the Center’s Frontiers of Innovation community. Project teams employ the IDEAS Impact Framework approach to program development and evaluation to learn how an intervention works, for whom it works best, and in what contexts. Read more about Innovation Clusters.

The PIC Practice Sites

  • Albuquerque, NM (Young Children’s Health Center)
  • Austin, TX (People’s Community Clinic)
  • Boston, MA (Boston Children’s Hospital Primary Care)
  • Bronx, NY (Montefiore Medical Group)
  • Los Angeles, CA (AltaMed at Children’s Hospital Los Angeles)
  • Minneapolis/St. Paul, MN (Children’s Hospitals and Clinics of Minnesota)
  • Oakland, CA (University of California, San Francisco Pediatrics)
  • Revere, MA (MGH Revere HealthCare Center)

“As a pediatrician in the Innovation Cluster, learning from fellow pediatricians, community stakeholders, psychologists, and social work staff about how they manage families contending with chronic stress in their unique settings has been most valuable.… What’s been most interesting and exciting is experiencing how enthusiastic parent participants are about the potential for more objective measures of stress in their children and using the measures to guide interventions/management.”

–Nicole Brown, MD, MPH, Montefiore Medical Center, Bronx, NY

The Core Work of the Pediatric Innovation Cluster

Identifying challenges and unmet child or family needs at each pediatric site. Using tools based on the Center’s Three Principles to Improve Outcomes for Children and Families, PIC sites are engaging in an interactive process with clinical staff and parents to identify priorities for new practice strategies. Early examples include a weekly group designed to help parents engage in interactive play with their child, and an established young parent program that is ripe for fresh thinking around the structure and content of its clinic visits.

Incorporating biological measures of stress effects/resilience and behavioral measures of core child capacities into primary care. The PIC practice sites are testing whether these new measures are feasible to collect within the context of a primary care visit, and they are also learning how to ensure that the information that is obtained is both confidential and empowering to parents. Particular attention is being directed toward identifying and preventing unintended consequences before the final set of measures is ready for broad implementation. For example, teams are learning how to explain biological measures of stress effects as indicators of relative sensitivity to environmental influences (in other words, some children are more susceptible to adversity than others) and not markers of “normal” versus “pathological” development.

Integrating parents’ perspectives into the evolving PIC agenda. Community leaders have been full partners in the Center’s pediatric activities since the JPB Network was launched in 2015. We have also been working continuously with the FrameWorks Institute to gain better insight into what U.S. parents currently understand about the effects of stress on children’s health and development. Finally, each PIC site has recruited parent volunteers to help identify major challenges and unmet needs within their practice.

Early Lessons Learned

Success requires strong support from each practice site’s home institution, particularly in navigating the regulatory processes required to obtain approval for piloting new measures and intervention strategies for children.

The broad adoption of validated, scalable measures to identify priorities for intervention and to assess short-term impacts will provide an opportunity to make a strong case to third-party payers for services that show significant change on key indicators.

Active engagement of community leaders and parents provides an opportunity to empower a new generation of science-informed change agents to address broader structural issues related to diversity, equity, and inclusion that affect the health and development of all children.

Next Steps

With these lessons in mind, the PIC is undertaking the following activities:

  • Exploring how to better support practice sites that are experiencing significant institutional challenges (e.g., protracted bureaucratic processes).
  • Engaging expertise in health care finance and payment systems to help leverage our new measures to influence reimbursement for effective programs.
  • Continuing to follow our collaborative approach to measurement development and practice innovation in order to build trust, honor family strengths, avoid deficit thinking and inappropriate labeling, promote shared decision-making, and provide a potentially powerful platform for driving social change.

Learn More